View source for Pulseless arrest

==Immediate==
#Start CPR
#Give oxygen
#Attach monitor/defibrilator
#Rhythm shockable?

== V-Fib and Pulseless V-Tach (Shockable) ==
*Shock as quickly as possible and resume CPR immediately after shocking
**Biphasic - 200J
**Monophasic - 360 J
*Give Epi 1mg if (shock + 2min of CPR) fails to convert the rhythm
*Give antiarrhythmic if (2nd shock + 2min of CPR) again fails
**1st line: [[Amiodarone]] 300mg IVP w/ repeat dose of 150mg as indicated
**2nd line: [[Lidocaine]] 1-1.5 mg/kg then 0.5-0.75 mg/kg q5-10min
**Polymorphic V-tach: [[Magnesium]] 2g IV, followed by maintenance infusion

== Asystole and PEA (Non-Shockable)==
[[File:PEA.png|thumbnail]]
*[[epinephrine|Epi]] 1mg q3-5min

*3 & 3 Rule

Consider H's and T's
#Hypovolemia
#Hypoxia
#Hydrogen ion
#Hypo/hyperkalemia
#Hypothermia

#Tension pneumothorax
#Tamponade
#Toxins
#Thrombosis, pulmonary
#Thrombosis, coronary



See Also: [[ACLS (Treatable Conditions)]]

==General==
*A (adjunct) - Place oropharyngeal airway
*B (breathing) - place on [[Ventilator]] to assure slow ventilation rate (attach to BVM mask)
**10-12 bpm, 500cc tidal volume, Fio2 100%
*C (compressions) - Switch out providers q pulse check; use metronome
*D - defibrillation
**Ok to shock during compressions if wearing gloves and using biphasic device

*A (advanced airway)
**Use LMA (NOT ET tube - no break in compressions required)
*B (advanced breathing)
**Connect LMA to [[Ventilator]]
***Pressure control 20, RR 10, insp rate 1.5-2s
*C (advanced circulation)
**Place IO instead of central line
*D (differential)
**[[Ultrasound: In Shock and Hypotension]]

==See Also==
*[[ACLS (Main)]]
*[[Brain Death]]
*[[Post Cardiac Arrest]]
*[[Pediatric Pulseless Arrest]]

==Source==
*AHA 2010 ACLS Guidelines
*EMCrit Podcast #31

[[Category:Airway/Resus]]
[[Category:Cards]]